Question 1

Should I use ORBIT or HAS-BLED?

Accepted Answer

Both are valid. ORBIT is more convenient for DOAC patients (no labile INR required) and has slightly better calibration for high-risk patients. HAS-BLED includes modifiable risk factors (labile INR, alcohol, NSAIDs) which can guide a risk-reduction conversation. Many clinicians use both: HAS-BLED for initial assessment and ORBIT for longitudinal follow-up.

Question 2

Does the ORBIT score indicate when to stop anticoagulation?

Accepted Answer

A high ORBIT score is not an automatic reason to stop anticoagulation. It flags the patient for closer monitoring of haemoglobin/creatinine, and a review of concomitant antiplatelet or NSAID use. The net clinical benefit of anticoagulation usually remains positive even at high ORBIT scores.

Question 3

How often should ORBIT be re-calculated?

Accepted Answer

At least annually, or following any change in clinical status that affects the five components — new anaemia, kidney function decline, addition of antiplatelet therapy, or after a bleeding event.